By: David Thickett. David Thickett works at the University of Birmingham and a Professor in Respiratory Medicine. He has released a number of case studies looking at the health implications regarding e-cigarettes and vaping with a goal to learn the impact on lung tissues. Last Updated: August 14th, 2018.

Introduction

Electronic cigarettes, e-cigs, and any vaping device is known medically as ENDS, electronic nicotine delivery systems and were first introduced to the general public in 2010. Since then the use of ENDS has increased exponentially with smokers, ex-smokers, and some fear, with non-smokers too. Over the last few years, there has been a rise in the published materials on ENDS and the safety of vaping with varying opinion and effects being somewhat controversial.

There is no denying that the best e-cigarettes on the market do help with the reduction of smoking traditional cigarettes, but they are just a replacement nicotine delivery device and as such, they may precipitate a new long-term health problem for vapers.

This is becoming increasingly concerning as the e-cig develops further, with highly developed box mods with sub-ohm tanks modulating the higher levels of power to deliver more vaper than ever before. Using these high powered mods with the use of custom mixes of e-liquids or electronic cigarette liquids (ECL), it is becoming more and more concerning.

The E-Liquid (ECL)

The e-liquid found in all e-cig devices, where it be your basic cigalikes, pod pen or more advanced box mods contain humectants in this case they are vegetable glycerin (VG) and propylene glycol (PG). Nicotine is also added at different velocities to suit the addiction of the user.

These studies and many like it focus more on the concentrated ECL, or the non vaporized e-liquid. This does not really represent the true picture, as Dr. Joseph Allen stated in the Formaldehyde in E-Cigs study, the chemistry of e-liquid changes when heated and evaporated.

Effects of Vaping

Recently there have been some studies published that attempted using aqueous extract systems for a more physiological approach. These tests were using systems similar to those used to create traditional cigarette smoke extract (CSE). One study that used this technique was looking at the Effect of ECL and cigarette smoke condensate on Metabolome, however, the results were met with considerable dilution.

Problem with Past Studies

These studies and many like it demonstrate the impact of exposure to the e-liquids or ECLs, but not really the actual effect of vaping and the composition change of these humectants ingredients when heated and evaporated.

Our Goal

Our team at the University of Birmingham developed a new system to produce an e-cigarette vapor condensate (ECVC) which shows to be a more physiological method of extraction. We also hypothesized the chemical reaction when ECL is vaped, this would increase the toxic to living cells and exacerbate the effects of nicotine on the immune responses, responses to infection, inflammation etc.

With this new system, we are aiming at monitoring the true effect of vaping with and without nicotine on the Alveolar macrophages (AMs) which are a unique lung cell population that eliminate airborne irritants and infectious agents, along with measuring the effects on lung inflammation. Any disturbances to AMs function usually lead to an increase the risk of infection and chronic obstructive pulmonary disease (COPD).

Vaping Equipment

Although vaping is now in its fourth generation of devices, we decided to use a standard vape pen known as the Kanger e-cig pen similar to that shown above, which is a second generation device but one of the most popular used ENDs on the market. The device had a standard 650mAh battery and a 1.8ohm atomizer. This is common with all mouth to lung vape devices so proved a good model.

The e-liquid we used adhered to the US Food and Drug Administration (FDA) manufacturing standards and had both pharmaceutical grade nicotine and normal nicotine within at a relatively high level of 36mg. To avoid any contamination with results, the decision was to go with only unflavored ECLs mixed at 50:50 PG/VG.

Our Results

The results of our test were based on 8 non-smokers (5 men, 3 women) exposed to vaping with and without nicotine with the equipment described above.

We found a number of results, the first suggesting that vaping significantly increases the toxic levels of the e-liquid when vaped to the living cells. This, however, was hugely dependant on the nicotine, that is, with nicotine free e-liquids the results were much lower.

In short, we found the vapor from the e-liquid caused inflammation and more importantly impaired the activity of alveolar macrophages (or dust cells). Alveolar macrophages are phagocytes that play a critical role in homeostasis, host defense, the response to foreign substances, and tissue remodeling, cells that remove potentially damaging dust particles, bacteria, and allergens – Wikipedia.

Our Conclusions

This was only a small study, of which can be read in full at https://thorax.bmj.com/content/73/12/1161. We have concluded that vaping e-liquid does in fact have a chemical reaction that increases the toxic levels to the lungs. Although e-cigs and vaping is far healthier than traditional smoking, it is not completely safe and the long-term effects of vaping are still unknown and we should have a cautious skepticism that they are as safe as we are being led to believe.

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Professor David Thickett DM FRCP trained in Oxford and London. He was a specialist registrar in the South West region before doing his Diabetes mellitus (DM) thesis on acute respiratory distress (ARDS) in Bristol. He now works at the University of Birmingham in England as a reader since 2011 and was promoted to Chair in Respiratory Medicine in 2014.

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